Rough Sleepers: Dr. Jim O'Connell's urgent mission to bring healing to homeless people

By Tracy Kidder

NEW YORK TIMES BESTSELLER • The powerful story of an inspiring doctor who made a difference, by helping to create a program to care for Boston’s homeless community—by the Pulitzer Prize–winning, New York Times bestselling author of Mountains Beyond Mountains

“I couldn’t put Rough Sleepers down. I am left in awe of the human spirit and inspired to do better.”—Abraham Verghese, author of Cutting for Stone
 
A BEST BOOK OF THE YEAR: NPR, BookPage, Chicago Public Library

Tracy Kidder has been described by The Baltimore Sun as “a master of the nonfiction narrative.” In Rough Sleepers, Kidder tells the story of Dr. Jim O’Connell, a gifted man who invented a community of care for a city’s unhoused population, including those who sleep on the streets—the “rough sleepers.”

After Jim O’Connell graduated from Harvard Medical School and was nearing the end of his residency at Massachusetts General, the hospital’s chief of medicine made a proposal: Would he defer a prestigious fellowship and spend a year helping to create an organization to bring health care to homeless citizens? That year turned into O’Connell’s life’s calling. Tracy Kidder spent five years following Dr. O’Connell and his colleagues as they work with thousands of homeless patients, some of whom we meet in this illuminating book. We travel with O’Connell as he navigates the city streets at night, offering medical care, socks, soup, empathy, humor, and friendship to some of the city’s most endangered citizens. He emphasizes a style of medicine in which patients come first, joined with their providers in what he calls “a system of friends.”

Much as he did with Paul Farmer in Mountains Beyond Mountains, Kidder explores how Jim O’Connell and a dedicated group of people have improved countless lives by facing and addressing one of American society’s most difficult problems, instead of looking away.

• Language: English
• Publisher: Random House Publishing Group
• Release date: Jan 17, 2023
• ISBN: 9781984801449

Tracy Kidder

Tracy Kidder is the author of Home Town, Among Schoolchildren, and Old Friends. He has won both the Pulitzer Prize and the National Book Award. He lives in Massachusetts and Maine.

Book preview

II

The Art of Healing

1

Conscripted

Jim was sometimes asked how he came to be a doctor to homeless people, and what kept him going. At one public lecture, he answered the question this way: Most of the patients I’ve been close to over these thirty-two years are dead. So there’s a certain sadness and moral outrage that I can’t get rid of. But when you work with people who’ve had so little chance in life, there’s a lot you can do. You try to take care of people, meet them where they are, figure out who they are, figure out what they need, how you can ease their suffering. I was drafted into this job, I didn’t pick it, but I lucked into the best job I can imagine.

Jim had started Harvard Medical School later than most—at thirty, after a decade of adventure and quest. He had grown up in the Irish American working class of Newport, Rhode Island. He went on to Notre Dame, where he majored in philosophy and graduated as salutatorian of his class, a young man with many possible futures before him.

He tried out philosophy first, continuing his studies for two years at the University of Cambridge in England. But he quit that field soon afterward. I don’t think I had a mind for philosophy, he later said. What he did have was a mind for ideas connected to action. He went to Hawaii and spent two years teaching literature and coaching basketball at a high school. I left to keep looking, he remembered. He returned to Newport and tended bar for a time with a college friend. With their earnings they bought an old barn in northern Vermont and turned it into a dwelling of sorts. He decided to become a New England country lawyer, and then, by happenstance, he finally discovered his life’s work.

It was on a vacation trip with Cambridge friends in England. He had gone with them to the Isle of Man during the week of the Tourist Trophy motorcycle race, the island’s festive, noisy phase. They were out for a drive when a spectator’s motorcycle crashed on the road ahead. Jim’s friends went off for help, while Jim sat with the biker. The man’s leg had been cracked in half, a compound fracture, one end of the bone sticking out through the skin. Jim looked at the injured leg once and didn’t dare look again for fear of vomiting. Mostly he listened, a bartender’s art, while the man, a tough guy from Manchester in obvious agony and trying not to show it, told about the mistakes he’d made as a kid and how he’d ruined his marriage and earned his children’s enduring anger.

Listening to the man’s story, Jim felt he’d been granted a privilege. This was intimate contact with life, the very thing he had missed during all those years of reading philosophy. A doctor dealt with what all human beings have in common. A doctor could make a vital connection with anyone. You didn’t have to believe God sent you. You were on hand just because a man fell off his motorcycle and got a compound fracture. What Jim remembered thinking as he sat listening by the roadside, not looking at the broken leg, was wishful: This would be perfect, if I knew how to take care of that leg.

Back in Vermont, Jim resolved to become a country doctor. He applied to the University of Vermont’s medical school, but was told that at thirty he surely lacked the superhuman endurance that medical training required. So he settled for Harvard.

The year was 1978, when tuition didn’t yet cost half a lifetime of debt. He managed to pay most of his own way by tending bar on the side. He loved his four years at Harvard, mostly because he was learning how to actually do something. As usual, he excelled in his studies, and the venerable Massachusetts General Hospital accepted him for one of its scarce, prestigious residencies in internal medicine.

On match day, fourth-year medical students receive a letter telling them where they will serve their internships and residencies. Mass General had also chosen two of Jim’s best medical school friends. They went out that night to the Black Rose pub, both to celebrate and also to worry over the many warnings they’d heard about internship—the impossible hours, the scoldings one got from doctors and nurses. It was the Sunday of St. Patrick’s Day weekend, so the pub was packed and rowdy. Just then, the crowd was cheering for a man dressed all in green who was hopping from table to table, dancing a jig. He was small and agile, a leprechaun. When he jumped onto their table, he looked down at Jim and his friends, then paused in his dance, crouched down on his haunches, and said, What’s wrong with you guys? You look like you just heard you’re dyin’.

They were medical students, they explained, and today was match day. Soon they would become interns and never sleep again.

Oh my God! cried the man. He had a rich Boston accent. You poor sons of bitches! Don’t do it! Life is too shawht! Don’t do it! Then he rose and danced off.

Three months later, in an auditorium at Mass General, Jim sat amid a crowd of new doctors in crisp white coats, and at the lectern welcoming them stood that same man, the dancing leprechaun, transformed into the hospital’s assistant director. When the ceremony ended, he walked up to Jim, wearing a smile of recognition. I warned you, he said.

This was Dr. Tom Durant, an important figure at Mass General, informally its chief liaison officer to the regional powers. Friend of the Kennedys and Massachusetts governors and legislators, of Boston mayors and city councilors, and of many powerful women, many of whom were his patients. He played rugby for recreation. He also belonged to a school of medicine that conceives of physicians as doctors to society, many societies in his case. He managed to spend a lot of time in troubled countries, helping to create clinics in places like wartime Vietnam and refugee camps for survivors of the Cambodian slaughter.

During his three years inside the hospital, Jim got to know Durant only as an extravagant and admirable presence. In retrospect, he felt sure that Durant must had been keeping tabs on him during residency. Jim never confirmed this impression before Durant died, in 2001. But the man had seemed to know Jim’s background—that Jim came from the Irish working class and that he had tended bar. And Durant must have heard about Jim’s enthusiasm for working with a motley group of patients in Mass General’s community clinics and its emergency department, where one served impoverished people, AIDS patients, ailing prostitutes.

By the spring of 1985, Jim had all but completed his residency and seemed on his way to a brilliant career in mainstream medicine. For the past several months, he had been the senior resident in the ICU, where very sick people arrived at all hours from all over the world. And he had just been awarded a prestigious fellowship—in oncology, at Memorial Sloan Kettering in New York City. He was walking down Mass General’s long central corridor, flanked by glass and steel, feeling freshly accomplished, when Durant came up beside him, and said: Hey, Jim, how about we go up and pay a call on John Potts?

Potts was the hospital’s chief of medicine. Jim remembered feeling a touch of schoolboy anxiety, as if he were walking with Durant to the principal’s office. The chief’s office itself was decidedly—indeed deliberately, ostentatiously—lacking in ostentation, small with a big metal desk and metal chairs with the usual ersatz-leather upholstery. Potts and Durant must have planned the occasion. They took turns explaining their case to Jim.

Homelessness had risen alarmingly all over the country as well as in Boston. Emergency departments were jammed with unfortunate people who didn’t have homes or doctors. In response, the Robert Wood Johnson Foundation and Pew Charitable Trust had invited cities to compete for grants to build something called Health Care for the Homeless programs, which would integrate these poorest of the poor into a city’s mainstream medical care. Boston had applied for a grant. The terms required a doctor, but Durant’s friend Mayor Flynn couldn’t find one. Would Jim sign up to fill that slot for a year, just one year?

It was Potts who made the request. Durant lightened the mood. He recalled the bantering advice he’d given Jim and his friends three years before, from the tabletop at the Black Rose pub. I always told you not to be a doctor. You remember. But you went and did it, and this is what you’ve gotta do now.

Jim was thirty-seven, and he felt he didn’t have time for a detour in his career. After three years of 110-hour weeks inside Mass General, he had absorbed both its general code—to pursue excellence in medicine—and also a corollary, which was not to mistake yourself for an ordinary doctor. It was one thing to treat the excluded and despised inside the great hospital, another to imagine treating them in dreary clinics elsewhere.

But these were his distinguished elders. They carried the weight of the institution. Jim felt he’d been conscripted, but he couldn’t think of a way to refuse. He remembered saying that the project sounded interesting, then added, The one thing I fear is, I’ll be marginalized in my own profession. So, you guys, if I do this, you’ve got to make sure you won’t just cut me loose.

No, no, Potts said to Jim. Mass General wants to be part of this. We will send you as a full member of this hospital.

This at least was reassuring. Potts was both a scientist—his field was calcium—and a physician, and as chief, a fatherly figure of the comforting sort. He conceived of his role as enabling, he told me years later. Durant had made the pitch, but Potts owned the desk in that office and with it the authority to make promises and to see that they were kept.

It was only a year, Jim remembered telling himself. It would be his year of giving back. Then he would go on with his life.

2

Foot Soaking

On July 1, 1985, the day after Jim finished residency, he boarded a train on Boston’s old elevated Orange Line and headed toward the South End. It was a hot day in the city. He wore a collared shirt and necktie and pressed slacks. He had his stethoscope in a back pocket and no idea of what awaited him. He’d been told to go to the Pine Street Inn homeless shelter and report to the nurses’ clinic, whatever that was. A woman colleague who knew Jim back then remembered him as a trim athletic guy with brown hair and keen blue eyes. Handsome, of course, she said. And cheery, glad to see you. He wasn’t cocky, she insisted, indeed quite the opposite—diffident, self-effacing. He was self-assured about medicine, though. At that moment in his life he would have said, if pressed, that he didn’t know much about a lot of things, but he did know medicine.

Mass General had taken such good care of him, he told me, that he never suffered a lapse of confidence during his residency. And as he rode the train into the South End, he still felt enfolded by that grand institution. He was resigned to this year of service, even looking forward to it now. It would be a break from the pressures of residency, he figured. The only thing that looked difficult was budgeting a life on the salary, which was $40,000 a year, at that time less than half the median salary of an M.D. in internal medicine. As for doctoring, he was anxious to show the people in this nurses’ clinic how well he could do the job. Only a few days earlier, he’d been part of a team running Mass General’s ICU. The role of doctor in a clinic in a homeless shelter couldn’t possibly be as challenging. An old friend of his told me: I can imagine him thinking, ‘They’ll probably be glad to see me.’

He had lived in Boston for seven years, but you didn’t get to see a lot of the city through the windows of Harvard Medical School and Mass General. So this short trip felt like an adventure, the train bisecting increasingly ramshackle neighborhoods, which he could observe with an explorer’s fascination, not yet being implicated in their squalor.

Out of the jumble of memory, these scenes remained: The orange- brick Pine Street Inn, seen from the train, its Tuscan bell tower rising over acres of industrial buildings and dilapidated flophouses. A short walk through a neighborhood of abandoned aspirations, of vacant lots, sagging chain-link fences, dark-faced bars. Then, as he turned onto Harrison Avenue, a very long line of men snaking down the sidewalk and into the alley toward the Pine Street Inn’s front door—hundreds of men, all looking for beds, some carrying backpacks or garbage bags, some staggering, a few falling-down drunk. And finally the shelter’s lobby, a big room with a ceiling of pipes and heating ducts, the air full of odors and the clamor of voices. It felt like a train station, people milling about with no one clearly in charge. He had to look around for the door to the nurses’ clinic, a swinging double door. He could have been entering a saloon in a movie, unwarned and unarmed.

In the world of nursing, this clinic inside the Pine Street Inn shelter was a significant organization, the country’s first clinic run entirely by nurses and independent of other medical institutions. It was in part the byproduct of a change in nursing that had begun with the feminist movement of the 1960s. One keeper of that history is a retired nurse and nurse manager named Barbara Blakeney. She had organized and run one of Boston’s homeless shelters. Later, she’d served as president of the American Nurses Association, which represents the interests of America’s four million registered nurses. She told me: By the 1980s, nurses were starting to say, We have an area of practice that’s independent from physicians. Yes, we can partner with physicians, we can take orders from physicians, but in addition there’s the whole practice of nursing. It has a component that medicine does not attend to—that’s the human being and the context in which patients find themselves.

In Blakeney’s experience, the general treatment of homeless people in the city’s teaching hospitals had set an example of callousness. At the teaching hospitals, homeless people had very few advocates, and the homeless were often assigned to residents and interns to practice and learn on. She remembered a case where a homeless patient of hers went to Mass General’s cardiology department for a 9:00 a.m. appointment, was made to wait for hours until all the other patients had been seen, then was asked why he hadn’t bothered to take a shower that morning, and was finally seen by a medical student. The nurses at Pine Street could all tell such stories. Various state agencies now financed their clinic, but the nurses had founded it with donations, in a spirit of flight from hospitals and mainstream doctors and the dismissive treatment of homeless people.

Blakeney knew many of those nurses and had heard them talk about the prospect of their clinic being invaded by physicians. Some were cynical enough to say, ‘Yeah, medicine shows up when they can get reimbursed for it. We’ve been doing this for years without being paid.’

Many of the nurses at the clinic were in fact volunteers, working there in exchange for the chance to practice their art. Caring for homeless people is one department of nursing where you get to spend as much time as you need with a patient, Blakeney explained. "You have to spend a lot of time. Otherwise you won’t have any patients. That’s what attracted so many nurses to the Pine Street model. It didn’t matter how often Joe Smith came in. He could come every night, and you could take care of him. There was no insurance company saying, ‘You can only have six visits.’ We could give him what he needed. So the idea of moving to a medicalized model where there were fees for service—it would mean losing nursing independence. And the nurses felt threatened: ‘We don’t need medicine coming in here and changing what we do’."

Blakeney concluded: So Jim walking into Pine Street represented all those bad things to the nurses.

---

• • •

The morning when Jim arrived, the clinic was closed for lunch break but half a dozen nurses were already inside, awaiting him. In the cramped space near the clinic’s front desk, chairs were arranged in a semicircle with one chair facing the nurses, the chair meant for him. In his memory, he sat there surrounded by nurses. Their faces were stern. They said they weren’t interested in investing their time to train a doctor who planned to leave in a year. And if that was what he planned to do—to play doctor to a bunch of homeless men, earn their trust, have them learn to rely on him, and then desert them—it would be better if he didn’t come at all. He was probably looking for an interesting experience, they said. He probably thought he was doing a good deed.

They were warning him, in a way that made him feel accused of having committed that crime already—as he had, inwardly. He felt shocked, too shocked to feel offended.

When they finished with him, one of the nurses took his arm and led him outside to the lobby. This was Barbara McInnis. She was a nurse at the Pine Street clinic, technically employed by the state’s public health department to watch for outbreaks of tuberculosis. A number of people had told Jim that she was the person to know in the world of Boston homeless health care. He had imagined someone prepossessing, but the real Barbara McInnis was short and, to his doctor’s eye, a bit too heavy for good health. She was dressed not in a nurse’s uniform—she never wore one—but in a shapeless shift and sandals. He noticed that she had a turquoise cross tattooed on the inside of her wrist. He learned later that she was a lay Franciscan. That is, she believed in service and simplicity and in kindness to all creatures. She actually fed the mice in the alleys outside the shelter.

Her voice, though high and small, sounded gentle. The nurses had seemed hostile, but he shouldn’t take that to heart, Barbara said. Nurses had created this clinic, and they were proud of it, and many of them would be happy never to see a doctor on the premises. She disagreed. Homeless people ought to have the benefit of doctors’ skills. I really think we want doctors, she said. But you’ve been trained all wrong.

She later gave him a piece of paper, a copy of a page from a book with something like a poem printed on it, a message to healers, an injunction against insisting that anyone had to be healed. Just give love, it read in part. The soul will take that love / and put it where it can best be used. This came from Emmanuel’s Book: A Manual for Living Comfortably in the Cosmos. The words, it was said, came from the spirit of Emmanuel, channeled through one of the authors. Jim thanked Barbara for the

Reviews for Rough Sleepers

[theampersand · Rating: 4 out of 5 stars]

It's difficult to read "Rough Sleepers" without thinking of another Tracy Kidder book, "Mountain Beyond Mountains," his chronicle of Partners in Health, Dr. Paul Farmer's impossibly high-performing health care clinic in rural Haiti. I loved "Mountains Beyond Mountains," but when I mentioned Farmer to the one person I know who works in public health, she rolled her eyes. It's not hard to see why: Dr. Farmer was admirable, but we can't all be Dr. Farmer. You couldn't base a health care system on people like him, and you probably shouldn't try. So we hear a lot about gentrification, about what it's like to grow up with few to no resources, about how humans sometimes fall through the cracks of the already shaky systems we have set up to support the most vulnerable.

I half-suspect that Kidder heard this criticism — or something like it — before writing "Rough Sleepers". Dr. Jim O'Connell is described as a special individual, but he's not a saint. In fact, when he left Harvard Med, he figured he'd have a quiet, prosperous career doctoring somewhere or other He took a one-year assignment to attend to patients living hard on the streets of Boston for a year and then, having stumbled into his vocation, found himself unable to leave. While the author spends a lot of time informing us about the mechanics of homelessness: how to get a shelter bed, and where to sleep if you don't; how to get medical attention; how stay safe, and how many homeless people are addicted to drugs or alcohol. But he also keeps an eye on the larger causes of how people came to be homeless and why this social problem persists. While Kidder's strength as a writer may always be introducing us to remarkable people, this is a slightly more structurally focused book than "Mountains Beyond Mountains" was, and it's better for it.

This isn't to say that we don't meet a lot of interesting characters in "Rough Sleepers", from Barbara McInnis, a wonderfully dedicated nun who later had a homeless shelter named after her, to Tony, a mercurial, charismatic, and talented man living on the streets whose genuine gifts have been obscured by years of drug abuse and a very troubled upbringing. And there are, of course, a lot like him. At the end of the book, we see Dr. Jim contemplating retirement and thinking about how the Boston Health Care for the Homeless Street Team might get on without him. He also takes the author — and the reader — on a tour of a sort of photo gallery of patients he once helped on the city streets. In one sense, he and Kidder share the same mission: to preserve the memory of individuals that were nearly forgotten in life and would otherwise almost certainly be forgotten in death. For this reason — and for many others — "Rough Sleepers" feels like an important, almost necessary book. This one is less obviously inspiring than "Mountains Beyond Mountains," perhaps, but I'm glad that Kidder took the time to write it.

[spoko_1 · Rating: 4 out of 5 stars]

I have to admit, I was a bit skeptical of this book going in. I had a feeling it would be preachy, extolling the praises of its subtitular hero. But that isn’t what I found it to be. It’s a compassionate, poignant look at the interaction between our healthcare system and people who live on our urban streets. There are occasional moments of broad analysis, but essentially it’s human-level, day-to-day reporting on one group of healthcare providers and the particular unhoused individuals they serve. It’s a powerful narrative, well executed.

[bell7_1 · Rating: 5 out of 5 stars]

Author Tracy Kidder had the opportunity to ride with Dr. Jim O'Connell and his Street Team for five years, as they gave medical treatment and check-ins to "rough sleepers" - those homeless folks who generally elect to stay on the streets rather than go to a shelter - in Boston. He describes Dr. Jim's work, how he got there, and the various people he provides services to.

This was a really excellent book, but so difficult to describe. Kidder does a great job of profiling one man and his work, as well as zooming out and exploring the multifaceted challenges in truly eradicating homelessness, while telling you story of person after person affected by health problems, trauma, substance abuse, and more. Dr. Jim would be the first person to tell you he's not a saint - but he does work hard to bring health services to a population most would like to ignore, and he does it with grace and compassion. Indeed, he compares it often to the myth of Sisyphus, and feeling like you're starting over from square one over and over again. But he keeps going, keeps working, and for some folks, it really does make a difference.

[nyiper · Rating: 5 out of 5 stars]

Tracy Kidder can always tell a story in his writing and we are eventually focused primarily on Tony, an in and out Rough Sleeper who plays such a central roll in Dr. Jim O'Connell's truly incredible work trying to help the homeless in Boston. I kept wondering if maybe, instead of trying to house the homeless in apartments, at least many of them would be better off in a home situaiton....the way some elderly people are now being put in group homes, with someone in charge...kind of like a housemother, with family meals as well as medical issues tended to. Leaving the streets cuts them off from their friends who are experiencing the same street life and apartment isolation becomes impossible. Absolutely no easy answers to problems that arise from so many different situations, but often originate in truly horrific childhoods.

[yukon92 · Rating: 5 out of 5 stars]

Having read 2 of Mr. Kidder's other books I was thrilled to see this new title. And as with the other books, it didn't disappoint. His books are always well researched, detailed and yet written in a way that does not feel scholarly. I can't wait to see what he will publish next.

[maryreinert · Rating: 3 out of 5 stars]

I admit, I just skimmed most of this book which covers the work of Dr. Jim O' Connell in Boston. Dr. O'Connell works with the homeless in a clinic that has grown under his administration. He goes out on the streets and deals with people where they are. I was probably expecting more about the homeless people themselves - as to how they arrived in the situation they are in. However, there are several individuals such as a tall man named Tony who are featured. Life is hard, the answers aren't easy.

[nmele_4 · Rating: 5 out of 5 stars]

Asa volunteer for two decades in emergency shelters and street outreach programs, I am very interested in other experiences of people who are perhaps the most marginalized in all of the United States. Tracy Kidder's story of Dr. Jim O'Connell's life work certainly depicts life on the streets for the people we call "hardcore" homeless. This is an honest, unsentimental book which also manages to portray rough sleepers as human beings deserving of respect, not neglect, and dignity, not disgust.

[katyefk · Rating: 4 out of 5 stars]

I learned a lot about homelessness and it is a very depressing and unsolvable situation. Some things work for some people and other things work for others but for many, almost nothing works long term. Alcohol and drugs only continue the problem.
Having prenatal and supportive childhood families and programs to guarantee this downward cycle stops is the only way out of this.

[maowangvater · Rating: 5 out of 5 stars]

Being a former bartender provided excellent experience for Jim O’Connell. As a physician tending to the homeless population of Boston he had the transferable skills to listen sympathetically to the intoxicated ramblings of his patients without judgment while treating them for their physical ailments. Kidder in pristine and accessible prose starts his report on the outreach services in a van with O’Connell on a September night as the team from Massachusetts General Hospital seeks out what O'Connell terms “rough sleepers,” the homeless that spend their nights on the streets, on doorsteps, in tunnels under the Charles River, or in the abandoned buildings, subway stations, and piles of rubble. They would rather be out in the open, even in inclement weather, rather than in a shelter with others. One example is the schizophrenic who did not want to be in a noisy shelter with the loud voices of others because he would be unable to distinguish those of the people around him or those in his head. When he was alone in a tunnel, he knew if he heard other voices they were just in his mind.

In addition to the narrative of Boston Healthcare for the Homeless Program, specifically O’Connell, his fellow medical providers, and the many homeless clients, all with distinctive characteristics and stories, Kidder also reflects on the nature of the practice. Several times in the book it’s referred to as that of Sisyphus endlessly rolling a rock up a hill again and again and again. O’Connell himself uses Camus’s essay “The Myth of Sisyphus” and the French author’s conclusion that the task itself was ennobling even when the outcome was futile. Addressing his team O’Connell says, “We just have to enjoy the good days and accept the bad days. It’s sort of the theme of our work. Sisyphus. If you dont enjoy rolling the rock up the hill, this is not the job for you.”

He also observed, “Housing turns out to be more complicated than medicine. I wish we had a cocktail of drugs that would cure people of being homeless.” And at a fundraising gala he told the attendees, “I like to think of the problem of homelessness as a prism held up to society, and what we see refracted are the weakness in our healthcare system, our public health system, our housing system, but especially in our welfare system, our educational system, and our legal system—and our corrections system. If we are going to fix this problem, we have to address the weakness in all these sectors.”

[formerenglishteacher · Rating: 5 out of 5 stars]

I’ve been reading Tracy Kidder since his masterpiece, “Soul of a New Machine” came out in 1981. In fact, I’ve read nine of his 11 books, and have enjoyed every one of them. In fact, what led me to this book, aside from considerable attention in the media about it, was Kidder’s name on the book. If Tracy Kidder wrote it, it’s important and it’s good. And this book was no exception. Kidder tells the story of Jim O’Connell, a Boston doctor, Notre Dame and Harvard educated, who could have taken the easy road after that pedigree, but chose instead to devote his life to the most forgotten of all Americans, the homeless. His story isn’t a guilt trip, either. It’s the good, the bad, and often the ugliest of the ugly about the lifestyle with little judgement, either of the homeless themselves or the society that often turns a blind eye to these folks. As I said, it’s a Kidder book, so it’s important. Everyone should read anything Tracy Kidder writes. Everyone should read “Rough Sleepers.”

[nancyadair-1 · Rating: 5 out of 5 stars]

I was one. When we lived in Philadelphia and I worked downtown, I got used to seeing them. People sleeping on cardboard boxes over the subway vents. The man who sold pencils on the street corner. The young man who came to the house and asked my husband to hold his money, giving over a fist of change, fearful it would get stolen in the shelter. He would return when he needed it, and went into the store next door to buy a soda and a bag of chips. There was the woman with all her belongings in a shopping cart who once threw empty soda cans at me when I came out of the public library.

One time a man stopped me and asked for money. I took him into the McDonalds we were in front of and bought him whatever he wanted: a cup of coffee.

Reading Rough Sleepers, moved by the stories of the homeless who sleep outside, I wondered why I didn’t give the homeless I had encountered more thought. I was young, we didn’t have money, I was ignorant. Or was acceptance just plain easier?

Tracy Kidder’s story of the Harvard trained doctor who dedicated his life to serving the most needy is inspirational, disturbing, eye-opening. The position he accepted for a year before he went onto to a fellowship in cancer research became his life’s work. His background as a bar tender taught him how to listen. His childhood taught him how to stay calm and controlled.

His first duty was to wash the feet of the homeless. It was a medical necessity, but also a lesson in servitude. Dr. Jim learned that traditional medicine, based on profit and treating patients not people, didn’t work with this population. He needed to get to know them, earn their trust before he could treat them. Dr. Jim delayed the fellowship another year, then gave it up. He had found his life’s calling. He worked long hours, traveling the streets at night to check on patients. He gave up wealth and rank and a private life. He made a difference, forming decades long relationships with his patients.

It’s not just the good doctor that we come to know; we get deep into the stories of his patients like Tony. He was a good person, a peace maker, a volunteer. Like 90% of the homeless, he was also an addict. And a felon whose conviction for attempted rape barred him from obtaining housing or employment. He had mental health issues. Like 75% of the homeless, his childhood was filled with violence. Dr. Jim wondered what Tony could have been–if only. We come to care about Tony.

The book presents the complicated bureaucratic system that has failed the homeless. How low income housing disappears when building are upscaled, the tenants unable to find affordable alternatives. How for profit medical system fails this population. And how government’s cutback on spending and the closure of psychiatric hospitals, the lack of treatment for PTSD in veterans, all contributed to an increase in homelessness. As a society, we want to blame the poor and homeless for their situation. We don’t want our tax money to fund programs for people who are addicts and unemployed. We don’t want to know who the homeless are because its easier that way.

Rough Sleepers shows how a few people can make a huge impact, even in a flawed system. Dr. Jim treated the homeless as individuals of worth, ministered to their needs as he could. Its up to the rest of us to urge politicians to address the systemic issues behind homelessness.

I received a free egalley from the publisher through NetGalley. My review is fair and unbiased.

[jetangen4571 · Rating: 5 out of 5 stars]

documentary, biography, street-people, Boston, medical-doctor, medical-caring, nonfiction, narrative, new-skills, addiction, addictive-behaviors, homelessness, memories, memoir, documented*****

One man CAN make a difference (with a lot of help from others).
In Boston town a different sort of revolution happened and is still way ahead of most others. It is in the recognition and care of the people who have no address and are ignored by the masses. It is in providing health care (and where possible, housing) for those who have fallen through the cracks in The System. Through these pages we meet some of the individuals, nurses and doctors, and even some of the bureaucrats who either made it all work or became obstacles. There continues to be a great need out there and we need to face it and overcome. Take a lesson from Dr. Jim and the Street Team.
Couldn't be totally clueless about the matters exposed in this book as I am a retired RN (class of 1968) who worked the inner city in hospital and jails until 2011.
Everyone needs to experience this book!
I requested and received an EARC from Random House Publishing Group/ Random House via NetGalley. Thank you!